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Nghien ctiuduoc SThong tin thudc

JOURNAL OF PHARMACEUTICAL RESEARCH AND DRUG INFORMATION

TRU0NG DAI HOC Dl/OC HA NOI Oja chi: 13-15 LeThanh Tong - Hoan Kiem - Ha Noi Website: http://hup.edu.vn

ISSN 1859-364X

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Nghien cufu bao chenhu tirong nho mat piroxicam Bao Minh Huy, LeThi Ngpc

Truing Bai hoc DM Ha Not

Phan tich chi phi y te trVc tiep cua benh ung thu tai Khoa A6 -Benh vien Trung ifctng Qua n dpi 108 nam 2011

Nguyen Thi Thanh Huong', Nguyen OUc Canh', Nguyen BUc Trung2

1 Tracing Bai hoc Dupe Ha Not; 'Berth vien Trung uang Quart dpi 108

Oinh lupng dong thcri lamivudin, zidovudin va nevirapin trong thuoc khang HIV phoi hpp bang dien di mao quan

Nguyen Thi Thuy Linh, Pham Thi Thanh Ha Truing Dai hoc Dupe Ha Npi

Oanh gia hoat ti'nh adrogen cua cao dac Testin tren chupt cd'ng thifc nghiem

OoThi Nguyet Que, Nguyen Thu Hang Vu Van Dien, Ha Van Oanh

Truing Bai hoc Dupe Ha Npi

Nghien cuTu bao che liposome amphotericin B bang phUofrig phap hydrat hoa him vdi ta dupe distearoyl phosphatidylglycerol

Tran Thi Hai Yen, Mai Thuy Linh, Pham Thj Minh Hue Truing Bat hoc Dupe Ha Npi

Tong hpp mot so dan chat alcaloid co khung oxyprotoberberin Le Nguyen Thanh', Van Thi My Hue2, ChoWon-Jea3

' Vien Hoa sinh bien, Vien Han lam Khoa hoc va Cong nghe Viet Nam 1 Truing Bat hoc Dupe Ha Npi

'Khoa Dupe, Dai hoc Quoc gia Chonnam, Han Quoc

Bai tong quan Ddpc cpng dong: Xu hudng hoat dpng thpc hanh di/pc tren the gioi va tai Viet Nam

Do XuanThang Truing Dai hoc Dupe Ha Npi

Thong tin thuoc - canh giac dufqc 24 Ha huyet ap sau an va ha huyet ap to the

NgUcri dich: Tran Thuy Ngan.Vu Dang Hoang Nguon: US Pharm. 2011;37(2):44-S

Diem tin hoat dong 23 Le trao huy hieu 30 nam tuoi Odng

2Q Hoc tap, quan triet Nghj quyet Hoi nghj Ian thu' mVoi Ban chap hanh Trung vong Dang Khoa XI

TONG BIEN TAP PGS.TS. Nguyen Dang Hoa

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S6 3/2015 Nghien ctiuduoc Thong tin thuoc 1

THONG TIN THU6C - CANH GlAC DUOC

Ha huyet ap sau an va ha huyet ap tU the

Ngudi dich: Tran Thuy Ngan, Vu Oang Hoang Nguon: US Pharm. 2011;37(2):44-50

Hg huyet ap la thubt ngCt tuong 661 mo td huyet ap hg thap hon so vdi chi so b'tnh thudng cua benh nhan 66. Do khdng cd dinh nghia chudn chohg huyet dp, viec xdc dinh tan sudt va ty le mac cua benh nay thudng gap khd khan. Tren thuc te.dmgtso benh nhdn, huyet dp thdp duocxem Id binh thudng. Benh nhan co huyet dp tam thu trong khodng 90-100 mmHg thgm chicd theco tuoi tho trung binh cao hon so vdi benh nhdn co chi so huyet dp binh thudng.

Mac du chda can lo ngai khi huyet ap thap hon 120/80 mmHg, nhdng neu benh nhan cd trieu chdng lien quan den ha huyet ap nhd chdng mat, choang vang, cam giac khat qua mUc thi can dude kiem tra them (bang 1). Nhdng trieu chUng nay la ket qua cua su giam tudi mau d cac to chut quan trgng, neu keo dai cd the dan tdi pha huy to chde. Trong cac trudng hop nghiem trong hon, benh nhan cd the nga't. Vdi mot so benh nhan, ha huyet ap cd the do suy nhudc nen can phai nghi ngoi tren giudng. Ha huyet ap dot ngqt cd the gay nguy hiem den tinh mang. Ha huyet ap sau an (PPH) va ha huyet ap tuthe (OH) nam trong nhdng roi loan tim mach thddng gap nhat dan den nga va ngat.

Bang 1. Jrieu chdng da ha huyet ap

-Chdng mat hoac choang vang;

- Ngat; - Cam giac mat nude va khat bat thudng; - Mat tap trung; - Nhin md;

- Buon ndn; - Cam thay lanh, da am udt, nhqt nhat; -Thd nhanh va nong;

- Met mdi; -Tram ciim.

Cofche benh sinh Huyet ap dupe dieu hda bdi nhieu co che lien

quan vdi nhau.Theo phuong trinh thuy lUc hoc, huyet ap dqng mach la tich so cua toe do ddng mau dupe mo ta bdi cung luqng tim (cardiac output - CO) va sue

can mach phoi (pulmonary vascular resistance - PVR): BP = CO x PVR.

Hai yeu to nay lien tuc dieu hda huyet ap thong qua 3 co quan chinh la cac tieu dqng mach, cac tieu tinh mach sau mao mach va tim.Than kiem soat huyet ap gian tiep thong qua duy tri the tich djch nqi mach. Vdi 4 co quan nay, huyet ap dude kiem soat nhd phan xa thu cam nhan ap thong qua cac day than kinh tq chu ket hop vdi co che the dich. Ngoai ra, cac chat hoat mach td nqi mac mach mau nhu nitric oxyd va endothelin-1 cung dieu hda huyet ap bang each thay doi sdc can mach mau.

Sinh ly benh Ha huyet ap cd the do thay doi cung ludng tim

hoac sdc can mach phoi. Bai viet nay trao doi ve 2 kieu ha huyet ap: ha huyet ap sau an va ha huyet aptu the. Can luu y, hai kieu ha huyet ap nay cd co che cpng hop vdi nhau hon la co che hiep dong.

Ha huyet ap sau an Ha huyet ap sau an xay ra khi huyet ap tam thu

cua benh nhan giam it nhat 20 mmHg d td the ngoi hoac nam ngda trong vdng 120 phut sau bda an.Tuy ha huyet ap sau an khac vdi ha huye'tap tdthe, nhdng 2 kieu ha huyet ap nay cd the xay ra tren cung mot benh nhan. Ha huyet ap sau an thudng gap d ngddi cao tuoi, ngudi mac benh Parkinson hoac roi loan he than kinh tu chu. Ha huyet ap sau an cd the xay ra do mot hoac nhieu co che nhd: sd giai phdng cac peptid gian mach dudng tieu hda, giam phan xa thu cam nhan ap, co mach ngoai vi, giam cung luqng tim sau an, tang mau tai nqi tang sau an. Khoi luqng, khau phan, thdi diem an va nhiet do thUc an dudng nhu deu anh hudng den ha huyet ap sau an (bang 2).

34 Nghien ciiuduoc Thong tin thudc So 3/2015

THONG TIN THUOC - CANH GIAC D'dOC

Bang 2. Cdcyeu to cua baa an anh hddng den hoi chdng ha huyet ap sau an (PPH)

Thdi gian an: BQa sang va bUa trifa co nguy CO gay PPH cao hon.

Thanh phan bCta an: Cac bufa an giau carbohydrat, ngheo protein co nguy co gay PPH cao hon. Dac biet, viec nap glucose co the dan tdi PPH.

Nhiet do there an: Thud an co nhiet do cang cao thi nguy co ha huyet ap cang cao.

Khoiluong bda an: An nhieu nhung an it buta thudng gay PPH nhieu hon so vdi viec an nhieu bda vdi loqng nhd hon.

Ddocsmen khuyen benh nhan duytri td the nam ngda sau bda an. Dac biet, each nay cd the giup ich nhdng benh nhan mac ca ha huyet ap sau an va ha huyet ap to the. Odi vdi ngudi cao tuoi, udng du nude la yeu td quan trong giup ngan ngUa ha huyet ap sau an. Viec lUa chon bien phap dieu tri hieu qua hien tuong ddi han che. Cho den nay, cac thudc nhUcafein va octreotid da duqc sd dung; acarbose con dang trong giai doan nghien cUu thd nghiem.

Cafein: Mac du cafein duqc cho la cd tac dung ddi khang vdi cac thudc gian mach, co che nay van chUa duqc hieu biet day du. Tuy nhien, viec sU dung cafein trUdc bUa an vdi lieu 60-200 mg (tUdng dudng 1 -2 tach ca phe) cd the lam giam nguy co ha huyet ap sau an d mot so benh nhan. Cafein cd tac dung phu la gay tieu chay, run, rdi loan giac ngu va tim dap nhanh.

Octreotid: Octreotid duoc sU dung de dieu tri benh nhan tang huyet ap cao tudi mac hdi chUng ha huyet ap sau an va benh nhan suy giam chUc nang he than kinh tU chu. Thudc cd tac dung thong qua tang lUu luqng mau ndi tang va lUc can mach mau cang tay cung nhu ngan sU giai phdng cac hormon tuyen tuy va dudng rudt. Tuy nhien, octreotid cd gia thanh kha cao. Thudc duqc chi djnh tiem dudi da vdi 1 lieu duy

Bang 3. Cdc nguyen nhan gay hg huyet dp td the (OH)

nhat 25-50 microgam trUdc bUa an. Cac tac dung phu cd the gap cua thudc bao gdm dau tai noi tiem, tieu chay, budn ndn va rung tdc.

Acarbose: Acarbose cd tac dung lam giam nguy co ha huyet ap sau an d nhUng benh nhan suy giam chUc nang he than kinh tU chu. Mot phan thong qua lam giam phan huy carbohydrat phUc hop, acarbose Uc che hoat dqng cua alpha-glucosidase, lam giam bai tiet insulin (cd tac dung gian mach) va cac hormon dudng tieu hda khac. Dieu nay cung cd the giai thich tai sao khau phan carbohydrat trong bUa an cd tac dung ha huyet ap Idn nhat. Acarbose dupe chi dinh dung trUdc bUa an 20 phut vdi lieu 100 mg x 3 Ian/ ngay. Cac tac dung phu thudng gap bao gdm dau bung, tieu chay va day hoi.

Cac thudc nhu midodrin, dihydroergotamin, indomethacin, diphenhydramin, cimetidin, fludrocortison va vasopressin cung cd tac dung d cac mUc do khac nhau trong viec kiem soat ha huyet ap sau an.

Ha huyet ap t u t h e Theo Hiep hdi Than kinh TU chu Hoa Ky (American

Autonomic Society) va Vien Than kinh hoc Hoa Ky (American Academy of Neurology), ha huyet ap tuthe duqc dinh nghia la sU giam huyet ap tam thu it nhat 20 mmHg hoac huyet ap tam truong it nhat 10 mmHg trong vdng 3 phut d tuthe dUng. Can kiem soat hieu qua ha huyet ap tU the vi day la dau hieu du doan nguy co tU vong do benh tim mach, dac biet d ngudi cao tudi va benh nhan dai thao dudng. Ty le mac ha huyet ap tuthe d ngudi cao tudi la 5-30%, phu thudc vao benh nhan cd ha huyet ap tam thu hay ha huyet ap tam truong. Ha huyet ap tuthe cd the do ca nguyen nhan than kinh hoac khdng lien quan den than kinh. Cac nguyen nhan nay duoc chia thanh 4 nhdm: thudc, rdi loan than kinh tUchu, giam lUu luqng mau va cac rdi loan khac (bang 3).

Giam lifti lifting mau Xuat huyet, bong, nhiem trung, tieu nhieu hoac ra mo hoi nhieu, tang fluting huyet va dai thao nhat, benh Addison, u tuyen tuy, tieu chay man tinh, tang huyet ap do benh mach than, mat mudi do benh than, bieng an tam than.

Thuoc Thuoc Igi tieu, chen alpha, chen beta, thuoc dieu tri benh Parkinson, chong tram cam 3 vong, sildenafil, cac nitrat, insulin, con, thuoc gay nghien, phenothiazin, vincristin, Uc che giao cam, kich thich giao cam, thuoc an than thU yeu.

Roi loan than kinh tif chu

Hoi chUng Shy-Drager (suy thoai hoat dong cua he than kinh giao cam tien va hau hach), benh nao ting thuy, hoi chUng medullary plate, mat ngon ngufdo ton thtrong viing Wernicke, benh nao, nhoi mau nao da 6, xo cUng rai rac, chUng thoai hoa dang tinh hot, hoi chUng Bradbury-Eggleston.

Khac Loan nhip tim, dau that nguc, suy tim, nghen mach pho'i, u myxoma tam nht, tang kali mau, hoi chUng can tan tao ac tinh.

So 3/2015 Nghien cOuduoc Thdng tin thudc 35

THONG TIN THUOC-CAnHGIACDUOC i <

Viec dieu tri chu yeu nham cai thien trieu chdng va loai bo cac nguyen nhan nen. Co the khuyen khich benh nhan tang cubing bo sung muoi va nude nhu bddc dieu trj dau tien. Cac bien phap khdng dung thuoc de kiem soat ha huyet ap ta the bao gom dung giadng co do doc giup ep tinh mach va thqc hien cac dpng tac chong ha huyet ap trade khi bat dau dieu trj bang thuoc. Mot so dpng tac chong ha huyet ap nen dapc thdc hien trong khoang 30 giay moi Ian ddpc Met ke trong bang 4.

Bang 4. Mot so dpng tat chong ha huyet dpddi vdi ha huyet dp td the

Kieng chan;

Bat cheo chan vao nhau va co lai;

Co cd dai;

Cui ngadi tdvung eo;

Dam chan cham tai cho;

Nang cao hai chan.

Bat ky thuoc nao benh nhan dang sd dung cung cd the lien quan den cac trieu chdng cua benh nhan va kha nang nay can ddpc lam rd trddc khi bat dau dieu trj. 6 mot so trddng hpp, ha huyet ap cd the do sd dung cac thuoc dong thdi. Neu Ipi ich cua viec ngdng sd dung thuoc nghi ngd gay ha huyet ap khong vdpt trpi hon nguy co, can can nhac dung cac

(Anh ti/lieu Internet)

bien phap khac de kiem soat ha huyet ap. Ngoai ra, can tranh tang huyet ap d tdthe nam ngda (tac dung phu thddng gap khi dung thuoc dieu trj ha huyet ap) va suy tim sung huyet, dac biet d benh nhan dai thao dddng hoac mac benh thieu mau cue bo cotim.

Bien phap dieu tri bang thuoc

Thuoc cd the kiem soat tot ha huyet ap tdthe' neu dupe sd dung dung each. Mot so thuoc ddpc Met ke dddi day ddpc sd dung tren lam sang de dieu trj ha huyet ap td the nhdng chi djnh nay cd the da ddpc phe duyet hoac chda ddpc phe duyet chinh thdc cda co qaan quan ly ddpc pham.

Fludrocortison Fludrocortison la mot mineralocorticoid lam tang

the tich ngoai long mach va tang nhay cam alpha-adrenergic. Liea thddng dung la 0,1-0,2 mg/ngay, nhdng cung cd the tang len 0,4-0,6 mg/ngay. Nen sd dung fludrocortison d lieu thap nhat cd hieu qua do thuoc cd the lam qua tai djch, cung nhd gay ha kali maa va/hoac ha magnesi mau. Cd the can bo sung kali cho benh nhan khi dung lieu cao. Tuy nhien, viec dieu trj bj han che do thuoc cd the gay tang huyet ap d td the nam ngda. Ngoai ra, benh nhan cdng cd the gap dad dau, phu va tang can.

36 Nghien ciiu duoc Thong tin thuoc So 3/2015

THONG TIN THUOC - CANH GlAC D'JQC

Midodrin Midodrin la mot tien thuoc chUa co hoat tinh;

sau khi dung qua dudng uong, thuoc dupe chuyen hoa thanh desglymidodrin chu van chon loc alpha,-adrenergic. Desglymidodrin co tac dung cao hon 15 Ian midodrin. Day la chat co mach, co tac dung tot trong dieu trj ha huyet ap tuthe' do nguyen nhan than kinh. Midodrin khong co hieu qua tren benh nhan ha huye'taptuthe'dogiam khdi lupng djch.Thuoc cung co tac dung lam tang huyet ap tam thu dtUtheddng, giam cam giac choang vang, tang thdi gian co kha nang ddng va di cua ngudi benh.

Lieu khdi dau dupe khuyen cao cua midodrin la 2,5 mg x2-3 lan/ngay (dudng udng) va tang lieu tCrtu" den 10 mg x 3 lan/ngay chi doi vdi benh nhan cd dap dng vdi bien phap dieu trj ban dau. Thuoc bat dau cd tac dung sau 0,5-1 gid va keo dai trong tdi da 4 gid. Vdi lieu phap dieu trj toi Uu, nen trai rdng lieu dua tren thdi diem benh nhan gap phai trieu chdng nang nha't. Midodrin gay tang huyet ap d tU the nam ngda tren khoang 25% benh nhan; cd the giam tac dung nay bang each dung thudc it nha't 4 gid trUdc khi di ngu hoac ke nghieng giudng cua benh nhan. Can khuyen khich benh nhan theo ddi huyet ap thudng xuyen de phat hien trudng hpp tang huyet apqua mute 6 tuthe nam ngda. Benh nhan cung cd the gap gian ddng td, ndi da ga, dj cam, ngufa da dau, ngda toan than. Chdng chi djnh trong trudng hpp cd benh than, bi tieu, benh tim, u tuyen tuy thupng than hoac nhiem ddc tuyen giap.

Pyridostigmin Pyridostigmin cd tac dung cai thien tuong ddi it

nhung cd the nhan thay ddi vdi ha huyet ap tU the ma khdng gay tang huyet ap d tU the nam ngda. Pyridostigmin dc che acetylcholinesterase, lam tang dan truyen than kinh d hach tren dudng truyen phan xa nhan ap giao cam. 6 mot so benh nhan, suy giam chut nang than kinh td chu anh hudng den chat dan truyen than kinh acetylcholin. Do lam giam chuyen hda acetylcholin thong qua acetylcholinestease, pyridostigmin cai thien huyet ap the ddng, dac biet la huyet ap tam truong.

Pyridostigmincd tac dung d benh nhan ha huyet ap tuthe nhe vdi lieu 30-60 mg x 2-3 lan/ngay. Thudc cd the dupe dung ket hpp vdi midodrin 5 mg cho cac trudng hpp ha huyet aptuthe nang hon nhung sUket hpp nay chUa dupe nghien cUu day du. Thudc cd cac tac dung phu lien quan tdi he cho linergic nhu dau

co that vung bung, tieu chay, budn ndn va ndn, tieu nhieu Ian, co ddng td, md mat va tang tiet nude bpt. Cac tac dung phu nghiem trpng hon bao gdm block nhi that, loan nhjp tim, ha hoac tang huyet ap, ngat, ngdng tim, co that phe quan, phu phdi, Met, co giat va phan ve.

Chdng chi djnh dung thudc cho benh nhan tac nghen tieu hda hoac viem phuc mac. Than trpng khi sddung vdi benh nhan hen phe quan, benh tim mach, ddng kinh, cUdng giap, Parkinson, suy than hoac loet da day-tatrang.

Epoetin alpha Epoetin alpha cd tac dung cai thien tinh trang

thieu mau thudng lien quan den cac rdi loan than kinh tu chu. Thudc giup tang huyet ap d t u the ddng va cai thien trieu chdng khi thay ddi tu the d benh nhan ha huyet ap tu the. Lieu thudng dung la 25-75 Ul/kg x 3 lan/tuan tiem dudi da hoac tiem tTnh mach. Thong thudng, benh nhan dupe ke don sat bo sung de lam tang hematocrit. Dupe si nen trao ddi vdi benh nhan nhCfng phan dng phu tren dudng tieu hda cd the gap phai khi sd dung che pham bd sung sat. Ngoai ra, erythropoietin cung gay tang huyet ap d tuthe nam ngda, tang cam giac ngon mieng va tang cam giac vui ve.

Droxidopa (l-threo-3,4-dihydroxyphenylserine hoac l-DOPS)

Droxidopa la mot aminoacid, dupe chuyen hda thanh noradrenalin trong cdthe. Benh nhan gap cac rdi loan do suy giam chut nangthan kinh tu chu (nhu benh Parkinson) thudng mac ha huyet ap t u t h e do thieu chat dan truyen than kinh noradrenalin. Thudc cd tac dung bd sung chat dan truyen nay, nhd do kiem soat ha huyet ap tuthe. De dieu trj ha huyet ap tu the do nguyen nhan than kinh, droxidopa dupe khuyen cao sCrdung vdi lieu khdi dau 100 mg x 3 Ian/ ngay; cd the tang dan den lieu tdi da 1,8 g/ngay chia lam cac lieu nhd.

Vai tro cua ddpc si Dupe si ddng vai trd quan trpng trong cham sot;

dieu trj cho benh nhan ha huyet ap tuthe, td viec theo ddi deu dan huyet ap cua benh nhan den tu van benh nhan ve sinh hoat/ldi song va sCr dung thudc hpp ly. Ngoai ra, dupe si cung can khuyen khich ngudi benh thong bao lai cac thudc dang sd dung do cd the cac thudc nay lai cd anh hudng den trj so huyet ap.

S6 3/2015 Nghien cQu duoc Thong tin thuoc 37